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Wang Z, Albers FE, Wang SE, English DR, Lynch BM. Biased effects of pre-diagnostic physical activity on breast cancer survival: Systematic review and meta-analysis. Cancer Epidemiol 2024; 89:102544. [PMID: 38359727 DOI: 10.1016/j.canep.2024.102544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Pre-diagnostic physical activity is reported to improve survival for women with breast cancer. However, studies of pre-diagnostic exposures and cancer survival are susceptible to bias, made clear when applying a target trial framework. We investigated the impact of selection bias, immortal time bias, confounding and bias due to inappropriate adjustment for post-exposure variables in a systematic review and meta-analysis of pre-diagnostic physical activity and survival after breast cancer. METHODS Medline, Embase and Emcare were searched from inception to November 2021 for studies examining pre-diagnostic physical activity and overall or breast cancer-specific survival for women with breast cancer. Random-effects meta-analysis was used to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) comparing highest versus lowest pre-diagnostic physical activity. Subgroup meta-analyses were used to compare HRs of studies with and without different biases. ROBINS-E was used to assess risk of bias. RESULTS We included 22 studies. Women with highest versus lowest pre-diagnostic physical activity had higher overall and breast cancer-specific survival across most analyses. The overall risk of bias was high. We observed marked differences in estimated HRs between studies that did and did not adjust for post-exposure variables or have immortal time bias. All studies were at risk of selection bias due to participants becoming eligible for study when they have survived to post-exposure events (e.g., breast cancer diagnosis). Insufficient studies were available to investigate confounding. CONCLUSION Biases can substantially change effect estimates. Due to misalignment of treatment assignment (before diagnosis), eligibility (survival to post-exposure events) and start of follow-up, bias is difficult to avoid. It is difficult to lend a causal interpretation to effect estimates from studies of pre-diagnostic physical activity and survival after cancer. Biased effect estimates that are difficult to interpret may be less useful for clinical or public health policy applications.
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Affiliation(s)
- Ziyu Wang
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Frances Em Albers
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Sabrina E Wang
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Brigid M Lynch
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
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Bernal-Gómez M, Núñez-Álvarez V, Lluch-Gómez J, de la Torre-Hita C, Campini-Bermejo A, Perdomo-Zaldívar E, Rodríguez-Pérez L, Calvete-Candenas J, Benítez-Rodríguez E, Baena-Cañada JM. [Association between reproductive history, breast cancer subtype, and survival in premenopausal women]. Med Clin (Barc) 2024; 162:265-272. [PMID: 37985328 DOI: 10.1016/j.medcli.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Reproductive history influences breast cancer risk. We analysed its association with tumour subtype and survival in premenopausal women. PATIENTS AND METHODS Retrospective, observational study of premenopausal women with stage I-III breast carcinoma in the last 20 years. Review of reproductive history, clinical data, and treatments in health records. RESULTS In 661 premenopausal women (32.40% of 1377 total cases), median age was 47 years (19-53), menarche 12 (7-17), first delivery 28 (16-41) and number of deliveries 2 (0-9). One hundred and eleven (18.20%) were nulliparous. Three hundred and fifty-nine (58.80%) used natural lactation, with a median duration of 6 months. Anovulatory drugs were used by 271 (44.40%), with a median duration of 36 months. Associations were found between menarche <10 years and lower risk of luminal subtype (OR: 0.52, 95% CI: 0.28-0.94; P=.03), between menarche >11 years and lower risk of HER2 subtype (OR: 0.50, 95% CI: 0.26-0.97; P=.04) and between first birth >30 years and lower risk of triple negative subtype (OR: 0.40, 95% CI: 0.17-0.93; P=.03). The 20-year overall and disease-free survival probabilities were 0.80 (95% CI: 0.71-0.90) and 0.72 (95% CI: 0.64-0.79) respectively. Patients with ≥1 delivery had better overall survival than nulliparous patients (HR: 0.51, 95% CI: 0.27-0.96, P=.04). CONCLUSIONS The findings suggest an association between age at menarche and age at first delivery and breast cancer subtype. Nulliparity is associated with worse survival.
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Affiliation(s)
- Marta Bernal-Gómez
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España
| | - Violeta Núñez-Álvarez
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España
| | - Jaime Lluch-Gómez
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España
| | - Carlos de la Torre-Hita
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España
| | - Alicia Campini-Bermejo
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España
| | - Eduardo Perdomo-Zaldívar
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España
| | - Lourdes Rodríguez-Pérez
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España
| | - Julio Calvete-Candenas
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España
| | - Encarnación Benítez-Rodríguez
- Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España; Servicio de Medicina Preventiva, Hospital Universitario Puerta del Mar, Cádiz, España
| | - José Manuel Baena-Cañada
- Servicio de Oncología Médica, Hospital Universitario Puerta del Mar (HUPM), Cádiz, España; Instituto de Investigación e Innovación Biomédica de Cádiz (INIBiCA), Cádiz, España.
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Yu ZH, Lin Y, Wu PS, Lee CH, Chou CP. A prognostic nomogram for predicting breast cancer survival based on mammography and AJCC staging. Heliyon 2024; 10:e27072. [PMID: 38449621 PMCID: PMC10915383 DOI: 10.1016/j.heliyon.2024.e27072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
Rationale and objectives To develop a prognostic nomogram using mammography data and AJCC staging to predict breast cancer survival. Materials and methods A prognostic nomogram was created using data from 1000 women diagnosed with breast cancer at a medical cancer center in Taiwan between 2011 and 2015. The variables included age at diagnosis (≤60 or > 60 years), mammography purpose (screening or diagnostic), mammography modality (digital mammogram or digital breast tomosynthesis), and the 7th American Joint Committee on Cancer (AJCC) stage. The outcome predicted was breast cancer-related mortality. The nomogram utilized Kaplan-Meier analysis for all subsets and Cox proportional hazards regression analysis for prediction. The nomogram's accuracy was internally validated using the concordance index and receiver operating characteristic (ROC) curve analysis, focusing on 3-year and 5-year survival predictions. Results Participants' mean age at breast cancer diagnosis was 54 years (SD = 11.2 years). The 1-year, 3-year, and 5-year overall survival (OS) rates were found to be 99.7%, 95.3%, and 91.4%, respectively. The bootstrap-corrected concordance indices indicated the following: nomogram, 0.807 and AJCC, 0.759. A significant difference was observed between the nomogram's area under the curve (AUC) and the AJCC stage in predicting the probability of 5-year survival (p = 0.005). A nomogram, constructed based on mammography and AJCC, demonstrated excellent calibration through internal validation using bootstrapping. Conclusion The utilization of a nomogram that incorporates mammography data and the AJCC registry data has been demonstrated to be a reliable predictor of breast cancer survival.
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Affiliation(s)
- Zi-Han Yu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Radiology, Jiannren Hospital, Kaohsiung, Taiwan
| | - Yun Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Shan Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chao-Hsien Lee
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Fooyin University, Kaohsiung, Taiwan
- Department of Pharmacy, College of Pharmacy, Tajen University, Pingtung, Taiwan
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Le Cornet C, Jung AY, Johnson TS, Behrens S, Obi N, Becher H, Chang-Claude J, Fortner RT. Postdiagnosis circulating osteoprotegerin and TRAIL concentrations and survival and recurrence after a breast cancer diagnosis: results from the MARIE patient cohort. Breast Cancer Res 2023; 25:42. [PMID: 37069615 PMCID: PMC10108482 DOI: 10.1186/s13058-023-01625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/27/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Experimental studies suggest a role for osteoprotegerin (OPG) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in mammary tumor development and progression. These biomarkers have been minimally investigated with respect to outcomes in breast cancer patients. METHODS OPG and TRAIL were evaluated in blood samples collected from 2459 breast cancer patients enrolled in the MARIE study, a prospective population-based patient cohort, at median of 129 days after diagnosis. Participants were between ages 50 and 74 at diagnosis and recruited from 2002 to 2005 in two regions of Germany. Follow-up for recurrence and mortality was conducted through June 2015. Delayed-entry Cox proportional hazards regression was used to assess associations between OPG and TRAIL with all-cause and breast cancer-specific mortality, and recurrence, both overall and by tumor hormone receptor status. RESULTS Median follow-up time was 11.7 years, with 485 deaths reported (277 breast cancer-specific). Higher OPG concentrations were associated with a higher risk of all-cause mortality (hazard ratio for 1-unit log2-transformed concentration (HRlog2) = 1.24 (95% confidence interval 1.03-1.49). Associations were observed in women diagnosed with ER-PR- tumors or discordant hormone receptor status (ER-PR-, HRlog2 = 1.93 (1.20-3.10); discordant ERPR, 1.70 (1.03-2.81)), but not for women with ER + PR + tumors (HRlog2 = 1.06 (0.83-1.35)). OPG was associated with a higher risk of recurrence among women with ER-PR- disease (HRlog2 = 2.18 (1.39-3.40)). We observed no associations between OPG and breast cancer-specific survival, or for TRAIL and any outcome. CONCLUSIONS Higher circulating OPG may be a biomarker of a higher risk of poor outcome among women diagnosed with ER- breast cancer. Further mechanistic studies are warranted.
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Affiliation(s)
- Charlotte Le Cornet
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Audrey Y Jung
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Theron S Johnson
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Nadia Obi
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heiko Becher
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
- Department of Research, Cancer Registry of Norway, Oslo, Norway.
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Zimbalist AS, Caan BJ, Chen WY, Mittendorf EA, Dillon DAR, Quesenberry C, Cespedes Feliciano EM. Metabolic abnormalities and survival among patients with non-metastatic breast cancer. BMC Cancer 2022; 22:1361. [PMID: 36581817 PMCID: PMC9801571 DOI: 10.1186/s12885-022-10430-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Research on the impact of metabolic abnormalities on breast cancer prognosis is limited by small samples and assessment of laboratory values at a single time point, often prior to cancer diagnosis and treatment. In this population-based cohort, time-updated laboratory values were adjusted for cancer treatment to assess the association between metabolic risk factors (glucose, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides) and breast cancer survival. METHODS 13,434 women diagnosed with stage I-III breast cancer from 2005-15 at Kaiser Permanente were included. All outpatient fasting glucose, HDL-C, LDL-C, and triglyceride values from diagnosis through 2019 or death were extracted from electronic medical records. Risk of breast cancer-specific mortality was evaluated with Cox proportional hazards models adjusted for metabolic labs, demographics, body mass index, diabetes, dyslipidemia and anti-hypertensive medications, tumor characteristics (stage, ER and HER2 receptor status) and cancer treatment (use of chemotherapy, tamoxifen, and aromatase inhibitors). RESULTS Mean (SD) age at diagnosis was 62.3 (11.8) years. Over a median follow-up of 8.6 years, 2,876 patients died; 1,080 of breast cancer. Patients with low HDL-C (≤ 45 vs. > 45 mg/dL) had higher breast cancer-specific mortality (HR, 1.77; 95% CI, 1.53-2.05), as did those with elevated fasting glucose (> 99 vs. 60-99 mg/dL) (HR, 1.19; 95% CI, 1.03-1.37). Elevated levels of triglycerides and LDL-C were not associated with breast cancer-specific mortality. CONCLUSIONS High fasting glucose and low HDL-C evaluated over time after cancer diagnosis were associated with higher breast cancer mortality independent of cancer treatments and changes in other metabolic risk factors. Future studies should address whether pharmacologic or lifestyle treatment of glucose and lipids after breast cancer diagnosis can optimize survival outcomes.
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Affiliation(s)
- Alexa S. Zimbalist
- grid.280062.e0000 0000 9957 7758Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5Th Floor, Oakland, CA 94612 USA
| | - Bette J. Caan
- grid.280062.e0000 0000 9957 7758Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5Th Floor, Oakland, CA 94612 USA
| | - Wendy Y. Chen
- grid.62560.370000 0004 0378 8294Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115 USA ,grid.65499.370000 0001 2106 9910Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215 USA
| | - Elizabeth A. Mittendorf
- grid.62560.370000 0004 0378 8294Division of Breast Surgery, Brigham and Women’s Hospital, Boston, MA 02215 USA ,grid.65499.370000 0001 2106 9910Breast Oncology, Dana-Farber Brigham Cancer Center, Boston, MA 02215 USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA 02215 USA
| | - Deborah A. R. Dillon
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA 02215 USA ,grid.62560.370000 0004 0378 8294Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115 USA
| | - Charles Quesenberry
- grid.280062.e0000 0000 9957 7758Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5Th Floor, Oakland, CA 94612 USA
| | - Elizabeth M. Cespedes Feliciano
- grid.280062.e0000 0000 9957 7758Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5Th Floor, Oakland, CA 94612 USA
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Deneche I, Zoughailech D, Chirpaz E. Socioeconomic inequalities in breast cancer survival in Reunion Island: The contribution of stage at diagnosis as a mediator. Cancer Epidemiol 2022; 80:102249. [PMID: 36067573 DOI: 10.1016/j.canep.2022.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/29/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although breast cancer survival has improved in France, it appears that women living in deprived areas are more likely to die from breast cancer. However, no study has yet examined socioeconomic inequalities in breast cancer survival in La Réunion. Our objective was to examine whether socioeconomic inequalities in breast cancer survival exist in Reunion Island and whether stage at diagnosis could partly explain these differences. METHODS A population-based cohort study of all women on Reunion Island with primary breast cancer diagnosed between 2008 and 2016 was conducted. Each woman was assigned a deprivation index based on her area of residence at diagnosis. Net survival by deprivation group and stage at diagnosis was estimated by the non parametric Pohar Perme method. The role of stage (indirect effect) was assessed using a mediation analysis extended to the relative survival framework. RESULTS At five years, net survival was significantly lower in women living in the most deprived areas than in women living in the least deprived areas (81 % (95 % CI 77-86) and 91 % (95 % CI 89-94), respectively, p < 0.0001), and mediation analysis showed that the contribution of stage at diagnosis to these survival differences was 43 %. DISCUSSION Our result shows that although measures to promote earlier diagnosis are important, they would only reduce socioeconomic inequalities in breast cancer survival by 43 %. To further investigate these inequalities, future research should explore the role of unmeasured mediators, such as comorbidities and treatment received, as well as the impact of specific interventions that might address the differences in mediator distribution.
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Pang Y, Wei Y, Kartsonaki C. Associations of adiposity and weight change with recurrence and survival in breast cancer patients: a systematic review and meta-analysis. Breast Cancer 2022; 29:575-588. [PMID: 35579841 PMCID: PMC9226105 DOI: 10.1007/s12282-022-01355-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adiposity and weight change among patients with breast cancer are associated with mortality, but there is limited evidence on the associations with distant recurrence or other causes of death or on central adiposity. Moreover, the relationship with breast cancer subtypes and by menopause status is unclear. METHODS We conducted a systematic review and meta-analysis of prospective studies of breast cancer patients investigating the associations of general and central adiposity (body mass index [BMI] and waist circumference [WC], respectively), before and after diagnosis, and weight change, with all-cause mortality, breast cancer-specific mortality (BCSM), and recurrence. RESULTS 173 studies (519,544 patients, 60,249 deaths overall, and 25,751 breast cancer deaths) were included. For BMI < 1 year post diagnosis, compared with normal weight women, the summary relative risk (RR) for obese women was 1.21 (1.15-1.27) for all-cause mortality, 1.22 (1.13-1.32) for BCSM, 1.12 (1.06-1.18) for recurrence, and 1.19 (1.11-1.28) for distant recurrence. Obesity was associated with all-cause mortality and BCSM in patients with ER+ or HER2+ tumors, whereas no clear association was observed in patients with triple-negative tumors. Similar associations were observed by menopausal status. Stronger associations were observed in East Asians than Europeans. Central adiposity was associated with all-cause mortality, while large weight gain was associated with all-cause mortality, BCSM, and recurrence. CONCLUSION Higher adiposity is associated with all-cause mortality, BCSM, recurrence, and distant recurrence in breast cancer patients, with similar associations by menopausal status and some evidence of heterogeneity by subtypes. Weight gain is also associated with recurrence and survival among breast cancer patients.
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Affiliation(s)
- Yuanjie Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Yuxia Wei
- Institute of Environmental Medicine, Karolinska Institutet, C6 Institutet för miljömedicin, 17177, Stockholm, Sweden
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Roosevelt Drive, Oxford, UK.
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, Oxford, OX3 7LF, UK.
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Matar R, Crown A, Sevilimedu V, Goldfarb SB, Gemignani ML. Timing of Presentation and Outcomes of Women with Stage IV Pregnancy-Associated Breast Cancer (PABC). Ann Surg Oncol 2022; 29:1695-1702. [PMID: 34709494 PMCID: PMC9470501 DOI: 10.1245/s10434-021-10901-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pregnancy-associated breast cancer (PABC) and concurrent, or early development of, stage IV disease is uncommon. Given this rarity, and complexities surrounding pregnancy, data are limited regarding PABC treatment and outcomes. We evaluated oncologic, obstetric, and fetal outcomes of women with stage IV PABC in relation to presentation timing and treatment. PATIENTS AND METHODS Our retrospective review of an institutional database identified women with stage IV PABC from 1998 to 2018. PABC was defined as diagnosis during pregnancy or ≤ 1 year postpartum. Clinicopathologic, treatment, and outcome variables were compared between women diagnosed during pregnancy versus postpartum. RESULTS We identified 77 women (median age 35 years; interquartile range [IQR] 32-37 years): 51 (66%) in the postpartum group and 26 (34%) in the pregnant group, including 9 with therapeutic or spontaneous abortion. Among 17 women who continued pregnancy, no obstetric or fetal complications were noted. Clinicopathologic and treatment variables did not differ between groups. Of 43 women dead from disease, 15 had triple negative (TN) tumors. Median overall survival (OS) of TN tumors was 14 months (range 5-39 months); OS was associated with hormone receptor-positive and human epidermal growth factor receptor 2 (HER2) positive tumors (p < 0.01). At 31 months (range 0-137 months) median follow-up, the 5-year OS was 34% (95% confidence interval 21-46%), and did not differ among pregnant and postpartum groups (p = 0.2). CONCLUSIONS Women with stage IV TN PABC had high mortality rates despite multimodality therapy. Timing of presentation did not affect management decisions or OS, even for women who completed pregnancy. Further research to understand PABC biology, focusing on TN tumors, is warranted.
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Affiliation(s)
- Regina Matar
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shari B. Goldfarb
- Breast Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary L. Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Abada E, Kim S, Dozier K, Fehmi O, Jang H, Fehmi Z, Bandyopadhyay S. Estrogen receptor status has no prognostic relevance in metaplastic breast carcinoma. Cancer Treat Res Commun 2022; 33:100630. [PMID: 36058202 PMCID: PMC9742347 DOI: 10.1016/j.ctarc.2022.100630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metaplastic breast carcinoma (MBC) is a rare histologic variant of breast cancer characterized by the presence of glandular and non-glandular components. The prognostic significance of estrogen receptor (ER) status has been scarcely studied in these tumors. We therefore investigated the prognostic relevance of ER status in MBC within our patient population. DESIGN We reviewed MBC cases (n = 125) between January 2000 and September 2019. Histologic slides were reviewed for variables including tumor morphology and hormonal status. Additional clinical information was obtained from the electronic medical records. RESULTS Of the 125 patients, 15 (12%) had ER positive tumors and 110 (88%) had ER negative tumors. Eleven (73%) ER positive tumors had ER positivity > 10% and 4 (27%) had ER positivity ≤ 10%. ER positive tumors had a smaller median tumor size of 2.5 cm, compared with ER negative tumors with median tumor size 3.05 cm, however this difference was not statistically significant (P = 0.82). There were no statistical differences between ER positive and ER negative tumors in terms of histologic grade (P = 0.34), histologic subtype (P = 0.65), clinical stage (P>0.99) or human epidermal growth factor receptor 2 (HER2) expression (P = 0.29). There was also no difference in overall survival (OS) between ER positive and ER negative metaplastic breast cancers (HR = 0.35, 95% CI, 0.003-2.67, P = 0.39). CONCLUSION Our experience suggests that ER positivity has no prognostic relevance in MBC. Regardless of ER expression status, there were no statistically significant differences in overall survival between ER positive and ER negative MBC.
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Affiliation(s)
- Evi Abada
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Street, Detroit, MI, 48201, USA,Corresponding author at: Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Street, Detroit Michigan, 48201, USA. (E. Abada)
| | - Seongho Kim
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Keion Dozier
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Street, Detroit, MI, 48201, USA
| | - Omar Fehmi
- Department of Biomolecular Science, University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | - Hyejeong Jang
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Ziad Fehmi
- Department of Biomolecular Science, University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Street, Detroit, MI, 48201, USA
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Farvid MS, Barnett JB, Spence ND, Rosner BA, Holmes MD. Types of carbohydrate intake and breast cancer survival. Eur J Nutr 2021; 60:4565-4577. [PMID: 34152461 PMCID: PMC9938676 DOI: 10.1007/s00394-021-02517-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/10/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the associations of different types of carbohydrate intake after breast cancer diagnosis with breast cancer-specific and all-cause mortality. METHODS We prospectively assessed post-diagnostic intake of total sugar, added sugar, and natural sugar as well as carbohydrate from different sources, among 8932 women with stage I-III breast cancer that were identified in the Nurses' Health Study from 1980 to 2010 and Nurses' Health Study II from 1991 to 2011. Participants completed a validated food frequency questionnaire every four years after diagnosis and were followed up for death. RESULTS We prospectively documented 1071 deaths due to breast cancer and 2532 all-cause deaths, over a mean of 11.5 years of follow-up. After adjustment for confounding variables, greater post-diagnostic total sugar intake was suggestively associated with greater risk of breast cancer-specific mortality [hazard ratio (HR)Q5vsQ1 = 1.16, 95% confidence interval (CI ) = 0.95-1.41; Ptrend = 0.02] and significantly associated with greater risk of all-cause mortality (HRQ5vsQ1 = 1.23, 95% CI = 1.08-1.41; Ptrend = 0.0001). Greater post-diagnostic added sugar intake was significantly associated with greater risk of all-cause mortality (HRQ5vsQ1 = 1.20, 95% CI = 1.06-1.36; Ptrend = 0.001). Post-diagnostic natural sugar (occurring in foods and not added as an ingredient) intake was not associated with mortality risk. Greater post-diagnostic fructose intake was significantly associated with greater risk of breast cancer-specific mortality (HRQ5vsQ1 = 1.34, 95% CI = 1.10-1.64; Ptrend = 0.005) and all-cause mortality (HRQ5vsQ1 = 1.16, 95% CI = 1.02-1.32; Ptrend = 0.01). High post-diagnostic intake of sucrose was associated with higher risk of breast cancer-specific and all-cause mortality. Increased post-diagnostic intake of carbohydrate from fruit juice was significantly associated with higher risk of breast cancer-specific and all-cause mortality and carbohydrate from vegetables was significantly associated with lower risk of all-cause mortality. High post-diagnostic intake of carbohydrate from potatoes was suggestively associated with higher risk of breast cancer-specific mortality and carbohydrate from refined grains was suggestively associated with higher risk of all-cause mortality. CONCLUSIONS We found that higher total sugar intake, especially added sugar, sucrose, and fructose, as well as carbohydrate from fruit juice after a breast cancer diagnosis were associated with poorer prognosis. High post-diagnostic intake of carbohydrate from vegetables was associated with reduced risk of mortality.
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Affiliation(s)
- Maryam S. Farvid
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Junaidah B. Barnett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicholas D. Spence
- Department of Sociology and Department of Health and Society, University of Toronto, Toronto, ON, Canada
| | - Bernard A. Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Michelle D. Holmes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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11
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Yadav SK, Silwal S, Yadav S, Krishnamoorthy G, Chisti MM. A Systematic Comparison of Overall Survival Between Men and Women With Triple Negative Breast Cancer. Clin Breast Cancer 2021; 22:161-169. [PMID: 34419351 DOI: 10.1016/j.clbc.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/03/2021] [Accepted: 07/02/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Triple-negative breast cancer (TNBC) in men is very rare. The clinical characteristics, prognostic factors, and overall survival of men with TNBC have not been characterized. METHODS The study population consisted of men and women with a diagnosis of stage I-III TNBC between 2010 and 2016 in the National Cancer Database. Baseline demographic and tumor characteristics between men and women were compared using Pearson's Chi-Square test for categorical variables and Mann-Whitney U test for continuous variables. Kaplan-Meier and multivariate Cox proportional hazards regression model was used to compare survival and identify prognostic factors. RESULTS A total of 311 men and 95,406 women with TNBC were included in the final analysis. The 3-year and 5-year overall survival was 74.8% and 68.8% in men, while it was 83.2% and 74.8% in women, respectively. In multivariate analysis, men were found to have a significantly worse overall survival compared to women (HR, 1.49, 95% CI, 1.19-1.86, P= .01). Older age at diagnosis, higher TNM stage, undergoing mastectomy and not undergoing chemotherapy or radiation were identified as independent negative prognostic factors in men with TNBC. CONCLUSION In one of the largest studies of men with TNBC, men were noted to have a poorer overall survival compared to women, despite adjusting for usual prognostic factors. Further research into differences in tumor biology, treatment patterns and compliance with therapy between men and women are needed to understand the underlying etiologies for the survival difference in TNBC.
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Affiliation(s)
| | - Swechchha Silwal
- Department of Internal Medicine/Transitional Year, Detroit Medical Center Sinai Grace Hospital, Detroit, MI
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12
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Ortega Expósito C, Falo C, Pernas S, Pérez Carton S, Gil Gil M, Ortega R, Pérez Montero H, Stradella A, Martinez E, Laplana M, Salinas S, Luzardo A, Soler T, Fernández Montoli ME, Azcarate J, Guma A, Petit A, Benitez A, Bajen M, Reyes Junca JG, Campos M, Ruiz R, Ponce J, Pla MJ, García Tejedor A. The effect of omitting axillary dissection and the impact of radiotherapy on patients with breast cancer sentinel node macrometastases: a cohort study following the ACOSOG Z0011 and AMAROS trials. Breast Cancer Res Treat 2021; 189:111-120. [PMID: 34089119 DOI: 10.1007/s10549-021-06274-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the outcomes of implementing the ACOSOG Z0011 and AMAROS trials relevant to clinical practice, and to define target groups in whom to avoid or recommend axillary radiotherapy (ART). We also aimed to analyse the reduction in morbidity when axillary lymph node dissection (ALND) was omitted. METHODS A retrospective cohort study of T1-T2 patients with macrometastases at sentinel lymph node (SLN) who were treated between 2011 and 2020. Breast surgery included either lumpectomy or mastectomy. Patients with ≤ 2 positive SLN were divided into two cohorts by whether they received ART or not. Survival outcomes and morbidity were analysed by Kaplan-Meyer curves and Cox-regression, respectively. RESULTS 260 pN1a patients were included and ALND was avoided in 167 (64.2%). According the Z0011 results, 72 (43.1%) received no further ART; and based on AMAROS criteria 95 (56.9%) received ART. Median follow-up was 54 months. The 5-year overall survival was 96.8% in the non-RT cohort and 93.4% in the RT cohort (p = 0.19), while the respective 5-year disease-free survivals were 100% and 92.3% (p = 1.06). Lymphedema developed in 3.6% of patients after SLNB versus 43% after ALND (OR 20.25; 95%CI 8.13-50.43). Decreased upper-extremity range of motion appeared in 8.4% of patients after SLNB versus 31.2% after ALND (OR 4.95; 95%CI 2.45-9.98%). CONCLUSIONS Our study confirms that omitting ALND is safe and has high survival rates in patients with T1-T2 tumours and ≤ 2 positive SLNs. Adding ART could be a treatment option for patients who present other risk factors. Avoiding ALND with or without ART was associated with significantly less arm morbidity.
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Affiliation(s)
- Carlos Ortega Expósito
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
| | - Catalina Falo
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Sonia Pernas
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Samuel Pérez Carton
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Miguel Gil Gil
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Raul Ortega
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Héctor Pérez Montero
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Agostina Stradella
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Evelyn Martinez
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Maria Laplana
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Sira Salinas
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Ana Luzardo
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Teresa Soler
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | | | - Juan Azcarate
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Anna Guma
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Anna Petit
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Ana Benitez
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Maite Bajen
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Jose G Reyes Junca
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Miriam Campos
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Raquel Ruiz
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Jordi Ponce
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Maria J Pla
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - Amparo García Tejedor
- Bellvitge University Hospital: Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
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Buckley E, Elder E, McGill S, Kargar ZS, Li M, Roder D, Currow D. Breast cancer treatment and survival differences in women in remote and socioeconomically disadvantaged areas, as demonstrated by linked data from New South Wales (NSW), Australia. Breast Cancer Res Treat 2021; 188:547-60. [PMID: 33748922 DOI: 10.1007/s10549-021-06170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/24/2021] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. Reducing variations in cancer treatment and survival is a key aim of the NSW Cancer Plan. Variations in breast cancer treatment and survival in NSW by remoteness and socioeconomic status of residence were investigated to determine benchmarks. METHODS A retrospective cohort study used linked data for invasive breast cancers, diagnosed in May 2002 to December 2015 from the NSW Cancer Registry, with corresponding inpatient, and medical and pharmaceutical insurance data. Associations between treatment modalities, area socioeconomic status and residential remoteness were explored using logistic regression. Predictors of breast cancer survival were investigated using Kaplan-Meier product-limit estimates and multivariate competing risk regression. RESULTS Results indicated a high 5-year disease-specific survival in NSW of 90%. Crude survival was equivalent by residential remoteness and marginally lower in lower socioeconomic areas. Competing risk regression showed equivalent outcomes by area socioeconomic status, except for the least disadvantaged quintile, which showed a higher survival. Higher sub-hazard ratios for death occurred for women with breast cancer aged 70 + years, and more advanced stage. Adjusted analyses indicated more advanced stage in lower socioeconomic areas, with less breast reconstruction and radiotherapy, and marginally less hormone therapy for women from these areas. Conversely, among these women who had breast conserving surgery, there was higher use of chemotherapy. Remoteness of residence was associated in adjusted analyses with less radiotherapy and less immediate breast reconstruction. In these short term data, remoteness of residence was not associated with lower survival. CONCLUSION This study provides benchmarks for monitoring future variations in treatment and survival.
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14
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Roder D, Zhao GW, Challam S, Little A, Elder E, Kostadinovska G, Woodland L, Currow D. Female breast cancer in New South Wales, Australia, by country of birth: implications for health-service delivery. BMC Public Health 2021; 21:371. [PMID: 33596880 PMCID: PMC7890625 DOI: 10.1186/s12889-021-10375-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND NSW has a multicultural population with increasing migration from South East Asia, the Western Pacific and Eastern Mediterranean. OBJECTIVE To compare cancer stage, treatment (first 12 months) and survival for 12 country of birth (COB) categories recorded on the population-based NSW Cancer Registry. DESIGN Historic cohort study of invasive breast cancers diagnosed in 2003-2016. PATIENTS Data for 48,909 women (18+ ages) analysed using linked cancer registry, hospital inpatient and Medicare and pharmaceutical benefits claims data. MEASUREMENT Comparisons by COB using multivariate logistic regression and proportional hazards regression with follow-up of vital status to April 30th, 2020. RESULTS Compared with the Australia-born, women born in China, the Philippines, Vietnam and Lebanon were younger at diagnosis, whereas those from the United Kingdom, Germany, Italy and Greece were older. Women born in China, the Philippines, Vietnam, Greece and Italy lived in less advantaged areas. Adjusted analyses indicated that: (1) stage at diagnosis was less localised for women born in Germany, Greece, Italy and Lebanon; (2) a lower proportion reported comorbidity for those born in China, the Philippines and Vietnam; (3) surgery type varied, with mastectomy more likely for women born in China, the Philippines and Vietnam, and less likely for women born in Italy, Greece and Lebanon; (4) radiotherapy was more likely where breast conserving surgery was more common (Greece, Italy, and Lebanon) and the United Kingdom; and (5) systemic drug therapy was less common for women born in China and Germany. Five-year survival in NSW was high by international standards and increasing. Adjusted analyses indicate that, compared with the Australian born, survival from death from cancer at 5 years from diagnosis was higher for women born in China, the Philippines, Vietnam, Italy, the United Kingdom and Greece. CONCLUSIONS There is diversity by COB of stage, treatment and survival. Reasons for survival differences may include cultural factors and healthier migrant populations with lower comorbidity, and potentially, less complete death recording in Australia if some women return to their birth countries for treatment and end-of-life care. More research is needed to explore the cultural and clinical factors that health services need to accommodate.
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Affiliation(s)
- David Roder
- Cancer Information and Analysis, Cancer Institute New South Wales, Level 4, 1 Reserve Road, St Leonards NSW 2065, PO Box 41, Alexandria, NSW, 1435, Australia.
| | - George W Zhao
- Cancer Information and Analysis, Cancer Institute New South Wales, Level 4, 1 Reserve Road, St Leonards NSW 2065, PO Box 41, Alexandria, NSW, 1435, Australia
| | - Sheetal Challam
- Equity, Multicultural Program, Cancer Institute New South Wales, St Leonards, NSW, Australia
| | - Alana Little
- Cancer Information and Analysis, Cancer Institute New South Wales, Level 4, 1 Reserve Road, St Leonards NSW 2065, PO Box 41, Alexandria, NSW, 1435, Australia
| | - Elisabeth Elder
- Specialist Breast Surgery, Westmead Breast Cancer Institute, Westmead, NSW, Australia
| | - Gordana Kostadinovska
- Multicultural Health Service, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Lisa Woodland
- Priority Populations, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - David Currow
- Cancer Institute New South Wales, St Leonards, NSW, Australia
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15
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Lee JE. Diet Before and After Breast Cancer. Adv Exp Med Biol 2021; 1187:545-566. [PMID: 33983599 DOI: 10.1007/978-981-32-9620-6_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The incidence of breast cancer has dramatically increased recently in several Asian countries. This region has experienced rapid economic growth and demographic and environmental changes. Breast cancer rates vary substantially among countries, with a lower incidence in developing countries than that in Western countries. Given the upward trend of breast cancer incidence in Asian countries and the large variation in incidence around the world, dietary changes may contribute to breast cancer development. In particular, nutrients and foods from animal sources have drawn attention as potential causes of breast cancer given that obesity and energy balance appear to be important factors associated with breast cancer risk. However, prospective cohort and intervention studies do not support the hypothesis that diet in middle life influences breast cancer development. However, recent studies have provided better insight into the roles of dietary factors in specific types of breast cancers, such as estrogen receptor-negative (ER-) breast cancer. Some studies suggest that diet in early life may play a substantial role in breast cancer development, but data and evidence remain limited.Although etiologic and epidemiologic studies have long studied modifiable risk factors for breast cancer incidence, much remains to be explored regarding the role of diet after a breast cancer diagnosis. Several epidemiologic studies have explored the factors that improve breast cancer survival rates, including diet, physical activity, and body mass index (BMI). While there is evidence of the effect of BMI on breast cancer mortality, the effects of changing dietary habits after a breast cancer diagnosis on survival or recurrence are less clear. A report of the World Cancer Research Fund stated that evidence was not sufficient to draw firm conclusions about the effect of diet and nutrition on breast cancer prognosis, but it did suggest a link between diet and breast cancer survival.The global burden of breast cancer is increasing and breast cancer is a major and emerging health problem in both developed and developing countries. For example, the five-year survival rate for Korean breast cancer patients has improved from 78.0% in 1993-1995 to 92.7% in 2012-2016. This improvement emphasizes the importance of supportive care, diet, and quality of life for breast cancer survivors. However, we have limited data of non-Western breast cancer survivors. There is a need to examine the role of diet in breast cancer survival in both Western and non-Western regions.
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Affiliation(s)
- Jung Eun Lee
- Department of Food and Nutrition, Seoul National University, Seoul, South Korea.
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16
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Escala-Garcia M, Morra A, Canisius S, Chang-Claude J, Kar S, Zheng W, Bojesen SE, Easton D, Pharoah PDP, Schmidt MK. Breast cancer risk factors and their effects on survival: a Mendelian randomisation study. BMC Med 2020; 18:327. [PMID: 33198768 PMCID: PMC7670589 DOI: 10.1186/s12916-020-01797-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/25/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Observational studies have investigated the association of risk factors with breast cancer prognosis. However, the results have been conflicting and it has been challenging to establish causality due to potential residual confounding. Using a Mendelian randomisation (MR) approach, we aimed to examine the potential causal association between breast cancer-specific survival and nine established risk factors for breast cancer: alcohol consumption, body mass index, height, physical activity, mammographic density, age at menarche or menopause, smoking, and type 2 diabetes mellitus (T2DM). METHODS We conducted a two-sample MR analysis on data from the Breast Cancer Association Consortium (BCAC) and risk factor summary estimates from the GWAS Catalog. The BCAC data included 86,627 female patients of European ancestry with 7054 breast cancer-specific deaths during 15 years of follow-up. Of these, 59,378 were estrogen receptor (ER)-positive and 13,692 were ER-negative breast cancer patients. For the significant association, we used sensitivity analyses and a multivariable MR model. All risk factor associations were also examined in a model adjusted by other prognostic factors. RESULTS Increased genetic liability to T2DM was significantly associated with worse breast cancer-specific survival (hazard ratio [HR] = 1.10, 95% confidence interval [CI] = 1.03-1.17, P value [P] = 0.003). There were no significant associations after multiple testing correction for any of the risk factors in the ER-status subtypes. For the reported significant association with T2DM, the sensitivity analyses did not show evidence for violation of the MR assumptions nor that the association was due to increased BMI. The association remained significant when adjusting by other prognostic factors. CONCLUSIONS This extensive MR analysis suggests that T2DM may be causally associated with worse breast cancer-specific survival and therefore that treating T2DM may improve prognosis.
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Affiliation(s)
- Maria Escala-Garcia
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anna Morra
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sander Canisius
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg (UCCH), Cancer Epidemiology Group, Hamburg, Germany
| | - Siddhartha Kar
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Stig E Bojesen
- Copenhagen University Hospital, Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev, Denmark
- Copenhagen University Hospital, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Doug Easton
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Paul D P Pharoah
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Falstie-Jensen AM, Kjærsgaard A, Lorenzen EL, Jensen JD, Reinertsen KV, Dekkers OM, Ewertz M, Cronin-Fenton DP. Hypothyroidism and the risk of breast cancer recurrence and all-cause mortality - a Danish population-based study. Breast Cancer Res 2019; 21:44. [PMID: 30902106 PMCID: PMC6431068 DOI: 10.1186/s13058-019-1122-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Hypothyroidism may occur as a late effect of breast cancer-directed treatment, particularly after radiotherapy, but little is known whether hypothyroidism affects the prognosis after breast cancer. We investigated the association between hypothyroidism and breast cancer recurrence, and all-cause mortality. Methods In this population-based cohort study, we used national medical registries to identify all Danish women 35 years or older diagnosed with stage I–III, operable breast cancer between 1996 and 2009. Hypothyroidism was defined as hospital diagnoses ascertained via diagnostic codes, or as prescriptions for levothyroxine. Two analytic models were used: (i) hypothyroidism present at the time of the breast cancer diagnosis (prevalent) and (ii) hypothyroidism diagnosed during follow-up as a time-varying exposure lagged by 1 year (incident). Breast cancer recurrence was defined as any local, regional, or distant recurrence or contralateral breast cancer. All-cause mortality included death from any cause in any setting. We used Cox regression models accounting for competing risks to compute adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of breast cancer recurrence and all-cause mortality. Results The study cohort included 35,463 women with breast cancer with 212,641 person-years of follow-up. At diagnosis, 1272 women had hypothyroidism and 859 women developed hypothyroidism during follow-up. In total, 5810 patients developed recurrent breast cancer. Neither prevalent nor incident hypothyroidism was associated with breast cancer recurrence (adjusted HRprevalent 1.01, 95% CI 0.87–1.19; adjusted HRincident 0.93, 95% CI 0.75–1.16, respectively). Furthermore, no differences were seen for all-cause mortality for prevalent or incident hypothyroidism (adjusted HRprevalent 1.02, 95% CI 0.92–1.14, and HRincident 1.08, 95% CI 0.95–1.23, respectively). Stratification by menopausal status, oestrogen receptor status, chemotherapy, or radiotherapy did not alter the estimates. Conclusions Hypothyroidism present at diagnosis or during follow-up was not associated with breast cancer recurrence or all-cause mortality in women with breast cancer. Our findings provide reassurance to patients and their physicians that hypothyroidism is unlikely to impact on the clinical course of breast cancer or survival. Electronic supplementary material The online version of this article (10.1186/s13058-019-1122-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Mette Falstie-Jensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
| | - Ebbe Laugaard Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jeanette Dupont Jensen
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristin Valborg Reinertsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Olaf M Dekkers
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marianne Ewertz
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Deirdre P Cronin-Fenton
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
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Liu N, Johnson KJ, Ma CX. Male Breast Cancer: An Updated Surveillance, Epidemiology, and End Results Data Analysis. Clin Breast Cancer 2018; 18:e997-e1002. [PMID: 30007834 DOI: 10.1016/j.clbc.2018.06.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/24/2018] [Accepted: 06/19/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Male breast cancer is rare and understudied compared with female breast cancer. A current comparison with female breast cancer could assist in bridging this gap. Although conflicting data have been reported on male and female survival outcomes, data from 1973 through 2005 in the Surveillance, Epidemiology, and End Results (SEER) program have demonstrated that the improvement in breast cancer survival in men has fallen behind that of women. As treatment for breast cancer has improved significantly, an updated analysis using a contemporary population is necessary. MATERIALS AND METHODS An analysis of SEER data from patients with a diagnosis of primary breast cancer from 2005 to 2010 were included. A Cox regression model was used to examine the association between sex and breast cancer mortality after controlling for prognostic factors, including age, race, marital status, disease stage, estrogen and progesterone receptor status, lymph node involvement, tumor grade, surgery, and geography. Subgroup analyses were performed by race and stage. RESULTS We included a total of 289,673 breast cancer cases (2054 men) with a diagnosis from 2005 to 2010. The 5-year survival rate for male patients was lower than that for female patients (82.8% vs. 88.5%). After controlling for other factors, the risk of death in men was 43% greater than that in women during the follow-up period (hazard ratio, 1.43; 95% confidence interval, 1.26-1.61). Similar results were noted in the race and stage subgroup analyses. CONCLUSION In recent years, male breast cancer patients have had worse survival outcomes compared with those of female patients.
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Affiliation(s)
- Ning Liu
- Washington University Brown School of Public Health, St. Louis, MO
| | - Kimberly J Johnson
- Washington University Brown School of Public Health, St. Louis, MO; Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Cynthia X Ma
- Washington University Brown School of Public Health, St. Louis, MO; Section of Medical Oncology, Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
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Sun Y, Bao W, Liu B, Caan BJ, Lane DS, Millen AE, Simon MS, Thomson CA, Tinker LF, Van Horn LV, Vitolins MZ, Snetselaar LG. Changes in Overall Diet Quality in Relation to Survival in Postmenopausal Women with Breast Cancer: Results from the Women's Health Initiative. J Acad Nutr Diet 2018; 118:1855-1863.e6. [PMID: 29859758 DOI: 10.1016/j.jand.2018.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/22/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lifestyle factors are important for cancer survival. However, empirical evidence regarding the effects of dietary changes on mortality in breast cancer survivors is sparse. OBJECTIVE The objective was to examine the associations of changes in overall diet quality, indicated by the Healthy Eating Index (HEI)-2010 score, with mortality in breast cancer survivors. DESIGN This was a prospective cohort study from September 1993 through September 30, 2015. PARTICIPANTS/SETTING This study included 2,295 postmenopausal women who were diagnosed with invasive breast cancer and completed a food frequency questionnaire both before and after the diagnosis of breast cancer in the Women's Health Initiative. MAIN OUTCOME MEASURES The HEI-2010 score (maximum score of 100) was calculated based on consumption of 12 dietary components. The outcomes were mortality from all causes, breast cancer, and causes other than breast cancer. STATISTICAL ANALYSES PERFORMED Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios of mortality from all causes, breast cancer, and other causes. RESULTS Over 12 years of follow-up, 763 deaths occurred. Compared with women with relatively stable diet quality (±14.9% change in HEI-2010 score), women who decreased diet quality (≥15% decrease in HEI-2010 score) had a higher risk of death from breast cancer (adjusted hazard ratio 1.66, 95% CI 1.09 to 2.52). Increased diet quality (≥15% increase in HEI-2010 score) was not significantly associated with lower risk of death. These associations persisted after additional adjustment for change in body mass index. CONCLUSIONS Among women with breast cancer, decreased diet quality after breast cancer diagnosis was associated with higher risk of death from breast cancer.
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Drukker K, Li H, Antropova N, Edwards A, Papaioannou J, Giger ML. Most-enhancing tumor volume by MRI radiomics predicts recurrence-free survival "early on" in neoadjuvant treatment of breast cancer. Cancer Imaging 2018; 18:12. [PMID: 29653585 PMCID: PMC5899353 DOI: 10.1186/s40644-018-0145-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/27/2018] [Indexed: 01/09/2023] Open
Abstract
Background The hypothesis of this study was that MRI-based radiomics has the ability to predict recurrence-free survival “early on” in breast cancer neoadjuvant chemotherapy. Methods A subset, based on availability, of the ACRIN 6657 dynamic contrast-enhanced MR images was used in which we analyzed images of all women imaged at pre-treatment baseline (141 women: 40 with a recurrence, 101 without) and all those imaged after completion of the first cycle of chemotherapy, i.e., at early treatment (143 women: 37 with a recurrence vs. 105 without). Our method was completely automated apart from manual localization of the approximate tumor center. The most enhancing tumor volume (METV) was automatically calculated for the pre-treatment and early treatment exams. Performance of METV in the task of predicting a recurrence was evaluated using ROC analysis. The association of recurrence-free survival with METV was assessed using a Cox regression model controlling for patient age, race, and hormone receptor status and evaluated by C-statistics. Kaplan-Meier analysis was used to estimate survival functions. Results The C-statistics for the association of METV with recurrence-free survival were 0.69 with 95% confidence interval of [0.58; 0.80] at pre-treatment and 0.72 [0.60; 0.84] at early treatment. The hazard ratios calculated from Kaplan-Meier curves were 2.28 [1.08; 4.61], 3.43 [1.83; 6.75], and 4.81 [2.16; 10.72] for the lowest quartile, median quartile, and upper quartile cut-points for METV at early treatment, respectively. Conclusion The performance of the automatically-calculated METV rivaled that of a semi-manual model described for the ACRIN 6657 study (published C-statistic 0.72 [0.60; 0.84]), which involved the same dataset but required semi-manual delineation of the functional tumor volume (FTV) and knowledge of the pre-surgical residual cancer burden.
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Affiliation(s)
- Karen Drukker
- Department of Radiology, MC2026, 5841 S Maryland Ave, Chicago, IL, USA.
| | - Hui Li
- Department of Radiology, MC2026, 5841 S Maryland Ave, Chicago, IL, USA
| | - Natalia Antropova
- Department of Radiology, MC2026, 5841 S Maryland Ave, Chicago, IL, USA
| | - Alexandra Edwards
- Department of Radiology, MC2026, 5841 S Maryland Ave, Chicago, IL, USA
| | - John Papaioannou
- Department of Radiology, MC2026, 5841 S Maryland Ave, Chicago, IL, USA
| | - Maryellen L Giger
- Department of Radiology, MC2026, 5841 S Maryland Ave, Chicago, IL, USA
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van der Waal D, Verbeek ALM, Broeders MJM. Breast density and breast cancer-specific survival by detection mode. BMC Cancer 2018; 18:386. [PMID: 29618328 PMCID: PMC5885304 DOI: 10.1186/s12885-018-4316-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 03/27/2018] [Indexed: 01/05/2023] Open
Abstract
Background Breast density is known to affect breast cancer risk and screening sensitivity, but it may also be associated with breast cancer survival. The interpretation of results from previous studies on breast density and survival is complicated by the association between detection mode and survival. Here, we studied the effect of breast density on breast cancer-specific survival for different detection modes (screen-detected, interval ≤ 24 or > 24 months, non-participant). Methods Data from the Nijmegen (Dutch) breast cancer screening programme were used. Women diagnosed with invasive breast cancer between 1975 and 2011 were included. Breast density was assessed visually, based on a dichotomized Wolfe scale: ‘fatty breasts’ (≤25%) and ‘dense breasts’ (> 25%). Cox proportional hazard regression was used to obtain hazard ratios (HR). Results We identified 2742 eligible women, with a breast pattern available for 2233 women. A diagnosis of interval cancer (HR 2.06, 95% CI 1.62–2.61) led to a significantly increased risk of breast cancer death compared with screen-detected cancer. No significant cause-specific survival difference between women with dense and fatty breasts was observed (HR 0.94, 95% CI 0.77–1.15). The hazard was only higher for women with dense breasts among interval cancers ≤24 m (HR 1.07, 95% CI 0.74–1.56). The hazard appeared to be lower for women with dense breasts than for women with fatty breasts among screen-detected (HR 0.77, 95% CI 0.53–1.11) and interval cancers > 24 m (HR 0.80, 95% CI 0.53–1.20). None of the effects were statistically significant. Conclusions Detection mode is strongly associated with breast cancer death. No clear association is apparent between breast density and breast cancer death, regardless of detection mode.
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Affiliation(s)
- Daniëlle van der Waal
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands.
| | - André L M Verbeek
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands.,Dutch Expert Centre for Screening, PO Box 6873, Nijmegen, 6503, GJ, The Netherlands
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De Mulder H, Laenen A, Wildiers H, Punie K, Poppe A, Remmerie C, Lefrère H, Nevelsteen I, Smeets A, Van Nieuwenhuysen E, Han S, Van Limbergen E, Floris G, Vergote I, Neven P. Breast cancer subtype and survival by parity and time since last birth. Breast Cancer Res Treat 2018; 169:481-7. [PMID: 29426984 DOI: 10.1007/s10549-018-4701-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pregnancy affects breast cancer risk but how it affects the subtype and prognosis remain controversial. We studied the effect of parity and time since last birth on breast cancer subtype and outcome. PATIENTS AND METHODS We conducted a retrospective multivariate cohort study including all premenopausal women with early breast cancer aged ≤ 50 years (N = 1306) at diagnosis at the University Hospitals Leuven (Jan. 2000-Dec. 2009). Primary study endpoints were the breast cancer subtype, disease-free survival, and distant disease-free survival by parity and time since last birth. Statistical methods used were baseline-category logits models and Cox proportional hazard models. Multivariable models were used to correct for possible confounders. RESULTS Breast cancer subtypes did not differ between nulliparous (N = 266) and parous women (N = 1040) but subtypes differed significantly in parous women by time since last birth (p < 0.001). Tumors within 5 years of last birth were proportionally more likely triple negative and HER-2 like, even when corrected for age at diagnosis. After a mean follow-up period of 10 years, parous women had a better disease-free survival compared to nulliparous women (HR 0.733; CI 0.560-0.961; p = 0.025, HR 0.738; CI 0.559-0.974; p = 0.032 before and after correction for known prognostic factors, respectively). In parous women, a longer time since last birth was correlated with a longer disease-free survival compared to patients with a recent pregnancy (HR 0.976; CI 0.957-0.996; p = 0.018). However, after correction, this association completely disappeared (HR 1.010; CI 0.982-1.040; p = 0.480). CONCLUSION We observed a better disease-free survival for parous than nulliparous women. The influence of recent birth on disease-free survival is probably due to tumor and patient characteristics, as recent birth is associated with more aggressive subtypes.
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Piggott RP, Waters PS, Kerin MJ. The influence of breast cancer subtype on bone metastases development and survival in women with metastatic breast cancer. Ir J Med Sci 2016; 186:97-102. [PMID: 27734241 DOI: 10.1007/s11845-016-1512-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 10/01/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tumour metastatic disease reflects a complex interplay between tumour characteristics and local host factors. This complex relationship may have an influence on the development of metastatic disease and patient survival. Multiple factors of the primary tumour influence the development of metastases and survival in patients. Breast cancer subtype has been shown to influence patient prognosis and response to therapy. AIM The aim of our study was to correlate breast cancer subtype with bony metastatic disease and patient survival. METHODS All women undergoing breast cancer surgery in a single institution in Ireland between January 1990 and July 2012 were included in the study. A prospectively maintained database was reviewed and expanded retrospectively. Univariate and multivariate analysis was carried out. RESULTS Database interrogation identified 238 patients for inclusion. Patient demographics, tumour characteristics and survival data were analyzed. Average follow-up of patients was 57.6 months (range 1-272 months). Multivariate analysis identified oestrogen receptor positivity and presence of metastatic disease elsewhere as significant factors influencing the development of bone metastases. Breast cancer subtype did not influence the bone metastases development (p = 0.99). Breast cancer subtype influenced patients' overall survival (p < 0.001), bone disease-free survival (p < 0.001) and survival with bone disease (p < 0.001). Subtype did not influence distant disease-free survival. CONCLUSION Breast cancer subtype influences patients' overall survival, with luminal A and B subtypes associated with the best outcome. Bone metastases remain the most common form of breast cancer metastases but are not influenced by breast cancer subtype.
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Affiliation(s)
- R P Piggott
- Department of Surgery, Galway University Hospital, Galway, Ireland.
| | - P S Waters
- Department of Surgery, Galway University Hospital, Galway, Ireland
| | - M J Kerin
- Department of Surgery, Galway University Hospital, Galway, Ireland
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Shariff-Marco S, Yang J, John EM, Kurian AW, Cheng I, Leung R, Koo J, Monroe KR, Henderson BE, Bernstein L, Lu Y, Kwan ML, Sposto R, Vigen CL, Wu AH, Keegan TH, Gomez SL. Intersection of Race/Ethnicity and Socioeconomic Status in Mortality After Breast Cancer. J Community Health 2015; 40:1287-99. [PMID: 26072260 DOI: 10.1007/s10900-015-0052-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We investigated social disparities in breast cancer (BC) mortality, leveraging data from the California Breast Cancer Survivorship Consortium. The associations of race/ethnicity, education, and neighborhood SES (nSES) with all-cause and BC-specific mortality were assessed among 9372 women with BC (diagnosed 1993-2007 in California with follow-up through 2010) from four racial/ethnic groups [African American, Asian American, Latina, and non-Latina (NL) White] using Cox proportional hazards models. Compared to NL White women with high-education/high-nSES, higher all-cause mortality was observed among NL White women with high-education/low-nSES [hazard ratio (HR) (95 % confidence interval) 1.24 (1.08-1.43)], and African American women with low-nSES, regardless of education [high education HR 1.24 (1.03-1.49); low-education HR 1.19 (0.99-1.44)]. Latina women with low-education/high-nSES had lower all-cause mortality [HR 0.70 (0.54-0.90)] and non-significant lower mortality was observed for Asian American women, regardless of their education and nSES. Similar patterns were seen for BC-specific mortality. Individual- and neighborhood-level measures of SES interact with race/ethnicity to impact mortality after BC diagnosis. Considering the joint impacts of these social factors may offer insights to understanding inequalities by multiple social determinants of health.
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Abstract
BACKGROUND The problem of learning causal influences from data has recently attracted much attention. Standard statistical methods can have difficulty learning discrete causes, which interacting to affect a target, because the assumptions in these methods often do not model discrete causal relationships well. An important task then is to learn such interactions from data. Motivated by the problem of learning epistatic interactions from datasets developed in genome-wide association studies (GWAS), researchers conceived new methods for learning discrete interactions. However, many of these methods do not differentiate a model representing a true interaction from a model representing non-interacting causes with strong individual affects. The recent algorithm MBS-IGain addresses this difficulty by using Bayesian network learning and information gain to discover interactions from high-dimensional datasets. However, MBS-IGain requires marginal effects to detect interactions containing more than two causes. If the dataset is not high-dimensional, we can avoid this shortcoming by doing an exhaustive search. RESULTS We develop Exhaustive-IGain, which is like MBS-IGain but does an exhaustive search. We compare the performance of Exhaustive-IGain to MBS-IGain using low-dimensional simulated datasets based on interactions with marginal effects and ones based on interactions without marginal effects. Their performance is similar on the datasets based on marginal effects. However, Exhaustive-IGain compellingly outperforms MBS-IGain on the datasets based on 3 and 4-cause interactions without marginal effects. We apply Exhaustive-IGain to investigate how clinical variables interact to affect breast cancer survival, and obtain results that agree with judgements of a breast cancer oncologist. CONCLUSIONS We conclude that the combined use of information gain and Bayesian network scoring enables us to discover higher order interactions with no marginal effects if we perform an exhaustive search. We further conclude that Exhaustive-IGain can be effective when applied to real data.
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Affiliation(s)
- Zexian Zeng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xia Jiang
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard Neapolitan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Beyer KMM, Zhou Y, Matthews K, Bemanian A, Laud PW, Nattinger AB. New spatially continuous indices of redlining and racial bias in mortgage lending: links to survival after breast cancer diagnosis and implications for health disparities research. Health Place 2016; 40:34-43. [PMID: 27173381 DOI: 10.1016/j.healthplace.2016.04.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 04/20/2016] [Accepted: 04/29/2016] [Indexed: 11/18/2022]
Abstract
Racial health disparities continue to be a serious problem in the United States and have been linked to contextual factors, including racial segregation. In some cases, including breast cancer survival, racial disparities appear to be worsening. Using the Home Mortgage Disclosure Act (HMDA) database, we extend current spatial analysis methodology to derive new, spatially continuous indices of (1) racial bias in mortgage lending and (2) redlining. We then examine spatial patterns of these indices and the association between these new measures and breast cancer survival among Black/African American women in the Milwaukee, Wisconsin metropolitan area. These new measures can be used to examine relationships between mortgage discrimination and patterns of disease throughout the United States.
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Affiliation(s)
- Kirsten M M Beyer
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, 8701 Watertown Plank Road, P.O. Box 26509, Milwaukee, WI 53226-0509, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA.
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, 8701 Watertown Plank Road, P.O. Box 26509, Milwaukee, WI 53226-0509, USA
| | - Kevin Matthews
- Department of Geographical and Sustainability Sciences, University of Iowa, 316 Jessup Hall, Iowa City, IA 52242, USA
| | - Amin Bemanian
- Institute for Health & Society, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA
| | - Purushottam W Laud
- Division of Biostatistics, Institute for Health & Society, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA
| | - Ann B Nattinger
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509, USA
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27
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Abstract
The relationship between adiposity and breast cancer risk and prognosis is complex, with associations that differ depending on when body size is assessed (e.g., pre- vs. postmenopausal obesity) and when breast cancer is diagnosed (i.e., pre- vs. postmenopausal disease). Further, the impact of obesity on risk differs by tumor hormone receptor status (e.g., estrogen (ER) and progesterone (PR) receptor) and, among postmenopausal women, use of exogenous hormones (i.e., hormone replacement therapy (HRT)). In the context of these complexities, this review focuses on associations between childhood and adolescent adiposity, general adiposity, weight changes (i.e., loss and gain), abdominal adiposity, and breast cancer risk and survival. Finally, we discuss potential mechanisms linking adiposity to breast cancer.
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Affiliation(s)
- Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Shariff-Marco S, Gomez SL, Sangaramoorthy M, Yang J, Koo J, Hertz A, John EM, Cheng I, Keegan THM. Impact of neighborhoods and body size on survival after breast cancer diagnosis. Health Place 2015; 36:162-72. [PMID: 26606455 PMCID: PMC4684167 DOI: 10.1016/j.healthplace.2015.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 01/07/2023]
Abstract
With data from the Neighborhoods and Breast Cancer Study, we examined the associations between body size, social and built environments, and survival following breast cancer diagnosis among 4347 women in the San Francisco Bay Area. Lower neighborhood socioeconomic status and greater neighborhood crowding were associated with higher waist-to-hip ratio (WHR). After mutual adjustment, WHR, but not neighborhood characteristics, was positively associated with overall mortality and marginally with breast cancer-specific mortality. Our findings suggest that WHR is an important modifiable prognostic factor for breast cancer survivors. Future WHR interventions should account for neighborhood characteristics that may influence WHR.
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Affiliation(s)
- Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, CA, USA; Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford, CA, USA.
| | - Scarlett L Gomez
- Cancer Prevention Institute of California, Fremont, CA, USA; Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford, CA, USA.
| | | | - Juan Yang
- Cancer Prevention Institute of California, Fremont, CA, USA.
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, CA, USA.
| | - Andrew Hertz
- Cancer Prevention Institute of California, Fremont, CA, USA.
| | - Esther M John
- Cancer Prevention Institute of California, Fremont, CA, USA; Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford, CA, USA.
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, CA, USA; Stanford Cancer Institute, Stanford, CA, USA.
| | - Theresa H M Keegan
- Division of Hematology and Oncology, UC Davis School of Medicine, Sacramento, CA, USA.
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Duggan C, Ballard-Barbash R, Baumgartner RN, Baumgartner KB, Bernstein L, McTiernan A. Associations between null mutations in GSTT1 and GSTM1, the GSTP1 Ile(105)Val polymorphism, and mortality in breast cancer survivors. Springerplus 2013; 2:450. [PMID: 24083102 PMCID: PMC3786079 DOI: 10.1186/2193-1801-2-450] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 12/12/2022]
Abstract
Purpose Here we assessed associations between null mutations in glutathione-S-transferase (GST)T1 and GSTM1 genes, and the rs1695 polymorphism in GSTP1 (Ile105Val), and risk of breast cancer-specific (n=45) and all-cause (n=99) mortality in a multiethnic, prospective cohort of 533 women diagnosed with stage I-IIIA breast cancer in 1995–1999, enrolled in the Health, Eating, Activity, and Lifestyle (HEAL) Study. Methods We measured the presence of the null mutation in GSTT1 and GSTM1, and the rs1695 polymorphism in GSTP1 by polymerase chain reaction. We assessed associations between breast-cancer specific and all-cause mortality using Cox proportional hazards models. Results Participants with ER-negative tumors were more likely to be GSTT1 null (χ2=4.52; P=0.03), and African American women were more likely to be GSTM1 null (χ2=34.36; P<0.0001). Neither GSTM1 nor GSTT1 null mutations were associated with breast cancer-specific or all-cause mortality. In a model adjusted for body mass index, race/ethnicity, tumor stage and treatment received at diagnosis, the variant Val allele of rs1695 was associated with increased risk of all-cause (HR=1.81, 95% CI 1.16-2.82, P=0.008), but not breast cancer-specific mortality. The GSTT1 null mutation was associated with significantly higher levels of C-reactive protein. Conclusions GSTM1 and GSTT1 null genotypes had no effect on outcome; however the variant allele of rs1695 appears to confer increased risk for all-cause mortality in breast-cancer survivors. Given the limited sample size of most studies examining associations between GST polymorphisms with breast cancer survival, and the lack of women undergoing more contemporary treatment protocols (treated prior to 1999), it may be helpful to re-examine this issue among larger samples of women diagnosed after the late 1990s, who all received some form of chemotherapy or radiotherapy.
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Affiliation(s)
- Catherine Duggan
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
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Dorjgochoo T, Zheng Y, Gao YT, Ma X, Long J, Bao P, Zhang B, Wen W, Lu W, Zheng W, Shu XO, Beeghly-Fadiel A. No association between genetic variants in angiogenesis and inflammation pathway genes and breast cancer survival among Chinese women. Cancer Epidemiol 2013; 37:619-24. [PMID: 23850146 DOI: 10.1016/j.canep.2013.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 06/12/2013] [Accepted: 06/16/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Angiogenesis and inflammation are implicated in breast cancer prognosis; however, the role of individual germline variation in related genes is unknown. METHODS A two-stage candidate pathway association study was conducted among 6983 Chinese women. Stage 1 included 2884 women followed for a median of 5.7 years; Stage 2 included 4099 women followed for a median of 4.0 years. Cox proportional hazards regression was used to estimate the effects of genetic variants on disease-free survival (DFS) and overall survival (OS). RESULTS Stage 1 included genotyping of 506 variants in 22 genes; analysis was conducted for 370 common variants. Nominally significant associations with DFS and/or OS were found for 20 loci in ten genes in Stage 1; variants in 19 loci were successfully genotyped and evaluated in Stage 2. In analyses of both study stages combined, nominally significant associations were found for nine variants in seven genes; none of these associations surpassed a significance threshold level corrected for the total number of variants evaluated in this study. CONCLUSIONS No association with survival was found for 370 common variants in 22 angiogenesis and inflammation pathway genes among Chinese women with breast cancer. IMPACT Our data do not support a large role for common genetic variation in 22 genes in breast cancer prognosis; research on angiogenesis and inflammation genes should focus on common variation in other genes, rare host variants, or tumor alterations.
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Simpson HW, George D, Sothern RB, Griffiths K. The Chronobra identifies prevailing mammary vascularity as a candidate variable in breast cancer post-operative outcome prediction. Springerplus 2013; 2:241. [PMID: 23741657 PMCID: PMC3668130 DOI: 10.1186/2193-1801-2-241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 04/22/2013] [Indexed: 11/11/2022]
Abstract
We previously described a menstrual heat cycle of the breast in four groups of women (healthy, family history of breast cancer, benign breast disease, ‘cancer-associated’) who wore a thermometric brassiere (Chronobra). We now ask if ‘breast minus oral temperature’, indicating ‘breast-associated vascularity’, could be associated with breast cancer cell vascular access around different aspects of the menstrual cycle rhythm and survival. Thirty-six pre-menopausal breast cancer patients (average age: 38.97 y) were enrolled consecutively over 15 y and followed for more than 22 y after surgery in order to compare survival and peri-operative vascularity. Each subject wore the Chronobra, which provides an internal bioassay of the vascularity of both breasts, including the operated breast, during 1 h each evening at home for one menstrual cycle, and collected saliva for “free” progesterone to confirm pre-menopausal status and ovulation. Sixty-five healthy age-matched pre-menopausal women served as controls. Both oral and breast temperatures revealed menstrual cycle oscillations, rising just before ovulation until menses onset. Breast-adjusted vascularity also showed menstrual cycle oscillations, with levels differing significantly between the 3 groups during the luteal phase only. At the end of the follow-up span, 18 post-operative breast cancer patients had died from “disseminated” breast cancer and 18 were alive and well. Median follow-up time was 22.6 y for survivors, 6.2 y for non-survivors, and 21.0 y for controls (3 died from diseases unrelated to breast cancer). Based on ‘during luteal-phase breast-adjusted vascularity’, breast cancer survivors (mean ± SD: -1.65 ± 0.23°C) were significantly hypo-vascular (i.e., -0.23°C cooler) compared with controls (-1.42 ± 0.09°C), while non-survivors (-1.25 ± 0.12°C) were highly significantly hyper-vascular compared with survivors (+0.41°C warmer) and controls (+0.23°C warmer). This suggests that in pre-menopausal breast cancer patients, peri-operative mammary vascularity could offer an outcome test of survival and biologically may be on the “final common pathway” of any tumor to metastatic risk and recurrence.
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Affiliation(s)
- Hugh W Simpson
- University Department of Surgery, Royal Infirmary, Glasgow, G4 OSF UK ; University Department of Surgery, Royal Infirmary, Glasgow, G31 2ER UK
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